EP1569692B1 - Compositions de bétaïne et d'acide salicylique - Google Patents

Compositions de bétaïne et d'acide salicylique Download PDF

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Publication number
EP1569692B1
EP1569692B1 EP02779843A EP02779843A EP1569692B1 EP 1569692 B1 EP1569692 B1 EP 1569692B1 EP 02779843 A EP02779843 A EP 02779843A EP 02779843 A EP02779843 A EP 02779843A EP 1569692 B1 EP1569692 B1 EP 1569692B1
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European Patent Office
Prior art keywords
betaine
compound
aspirin
combination
acetylsalicylic acid
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EP02779843A
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German (de)
English (en)
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EP1569692A2 (fr
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Jallal Messadek
Rachid Ennamany
Michel Thiry
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K9/00—Medicinal preparations characterised by special physical form
    • A61K9/20—Pills, tablets, discs, rods
    • A61K9/2072—Pills, tablets, discs, rods characterised by shape, structure or size; Tablets with holes, special break lines or identification marks; Partially coated tablets; Disintegrating flat shaped forms
    • A61K9/2086—Layered tablets, e.g. bilayer tablets; Tablets of the type inert core-active coat
    • A61K9/209—Layered tablets, e.g. bilayer tablets; Tablets of the type inert core-active coat containing drug in at least two layers or in the core and in at least one outer layer
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/185—Acids; Anhydrides, halides or salts thereof, e.g. sulfur acids, imidic, hydrazonic or hydroximic acids
    • A61K31/205—Amine addition salts of organic acids; Inner quaternary ammonium salts, e.g. betaine, carnitine
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/60—Salicylic acid; Derivatives thereof
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P1/00—Drugs for disorders of the alimentary tract or the digestive system
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P19/00—Drugs for skeletal disorders
    • A61P19/06—Antigout agents, e.g. antihyperuricemic or uricosuric agents
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P29/00—Non-central analgesic, antipyretic or antiinflammatory agents, e.g. antirheumatic agents; Non-steroidal antiinflammatory drugs [NSAID]
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P3/00—Drugs for disorders of the metabolism
    • A61P3/08—Drugs for disorders of the metabolism for glucose homeostasis
    • A61P3/10—Drugs for disorders of the metabolism for glucose homeostasis for hyperglycaemia, e.g. antidiabetics
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P35/00—Antineoplastic agents
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P7/00—Drugs for disorders of the blood or the extracellular fluid
    • A61P7/02—Antithrombotic agents; Anticoagulants; Platelet aggregation inhibitors
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P9/00—Drugs for disorders of the cardiovascular system

Definitions

  • This invention relates to the pharmaceutical combination comprising at least:
  • the invention relates to pharmaceutical composition
  • a betaine and aspirin in a formulation wherein the betaine and aspirin are formulated together in a bilayered tablet, the aspirin being present in a first layer, and the betaine being present in a second layer in an amount at least five times the amount of aspirin.
  • Said pharmaceutical composition wherein the tablet includes a core and a coating layer surrounding said core and wherein one of the betaine and aspirin is present in the core and the other is present in the coating layer surrounding the core.
  • Glycine betaine is a molecule known for its osmo-protective properties, its cosmetic and pharmaceutical uses.
  • WO 0051596 discloses the use of betaine for the treatment of thrombosis not induced by homocystinuria.
  • said application discloses the combination of glycine betaine with a contrast agent.
  • antiaggregant treatment for preventing thrombosis with acetylsalicylic acid necessitates special precautions in use, such as overdose problems and unwanted side effects.
  • This treatment makes it necessary to monitor patients, due in particular to haemorrhage-related problems which can arise during or after medication, gastro-intestinal mucosa damages, as well as possible incompatibility with other drugs.
  • PCT/BE 02/ 00013 of one of the applicants discloses a pharmaceutical combination comprising a therapeutic effective amount of a therapeutically active agent with at least one haemorrhagic side effect, and a therapeutic effective amount of a compound of formula (CH 3 ) 3 N + (CH 2 ) n COO - with n an integer from 1 to 5, preferably glycine betaine or a pharmaceutically acceptable salt thereof, esters thereof, precursors thereof, and mixtures thereof for preventing or reducing said haemorrhagic side effect and/or for potentialising the therapeutic effect of said active agent.
  • acetylsalicylic acid is given as example.
  • the dosage forms given is the example 33 of said document comprise:
  • US Patent 4,703,045 discloses a therapeutic composition containing betaine salts for the treatment of hangover, said oral composition comprising a pain relieving amount of analgesic (see claim 1 of said patent).
  • unit doses according to compositions 4 and 12 of said patent comprises 200 mg acetylsalicylic acid for 2000 mg betaine citrate and other excipient
  • unit dose of composition 15 comprises 110 mg acetylsalicylic acid for 2000 mg betaine and other excipient.
  • the effervescent tablet of composition 19 comprises 250 mg of acetylsalicylic acid for 1750 mg betaine citrate and other excipient.
  • Unit composition containing less than 100 mg acetylsalicylic acid does not contain a pain relief amount of analgesic for a human having a weight of about 70 kg.
  • US 4,703,045 describes the use of a combination of 2000 mg betaine citrate and 200 mg acetylsalicylic acid for treating hangover.
  • Betaine citrate C 11 H 19 NO 9 - CAS: 17671-50-0
  • MW 192.12 citrate molecule
  • betaine anhydrous molecule MW 117.15
  • Betaine-Palmitate reduces acetylsalicylic acid-induced gastric damage in rats
  • Zoelli et al Scandinavian Journal Gastroenterology, vol. 36, no. 8, August 2001
  • Betaine-palmitate or palmitic acid prevented ASA-induced disruption of the mucosal barrier.
  • betaine alone failed to have protective effect against ASA induced injuries in all tested conditions i.e. Histology, planimetry and ATP measurement and Vascular permeability index, as reported in the results chapter of the publication.
  • FR 2403799 describes injectable aqueous solutions comprising1000 weight parts of water, 20-100 weight parts of aspirin and 10-100 weight parts glutamic acid + betaine and also 105-150 weight parts of Arg or Lys.
  • the ratio acetylsalicylic acid/betaine is 25:1.
  • US 4,066,756 describes bilayer tablets with aspirin in one layer and another active in the other layer.
  • Aspirin is envisaged in low doses: 60-600 mg.
  • the other active ingredient to reduce aspirin side effects is disodium cromoglycate. No mention or suggestion is made to glycine betaine.
  • WO 02/066002 describes bilayer tablets with aspirin in one layer and another active in the other layer. Aspirin is envisaged in low doses: 50-1000 mg. The other active, ranitidine, reduces the aspirin's side effects. No mention or suggestion is made to glycine betaine.
  • US Patent 6,235,311 discloses a pharmaceutical composition which is useful for cholesterol lowering and reducing the risk of a myocardial infarction, which includes a statin, such as pravastatin, lovastatin, simvastatin, atorvastatin, cerivastatin or fluvastatin, in combination with aspirin, in a manner to minimize interaction of aspirin with the statin and minimize side effects of aspirin.
  • This pharmaceutical composition comprising a statin cholesterol lowering agent and aspirin in a formulation to reduce statin/aspirin interaction wherein the statin and aspirin are formulated together in a bilayered tablet, the aspirin being present in a first layer, and the statin being present in a second layer.
  • the pharmaceutical composition as claimed in said patent is a the tablet including a core and a coating layer surrounding said core and wherein one of the statin and aspirin is present in the core and the other is present in the coating layer surrounding the core.
  • French Pat. No. 2590 M of 1963 describes the combination of betaine citrate with aspirin to buffer aspirin were the highest ratio of betaine citrate/aspirin is 5:3 i.e. 1,67 times the amount by weight of betaine citrate versus aspirin. The lowest amount of aspirin in each unitary dose is 300 mg.
  • Betaine salicylate is prepared through the interaction of betaine base and salicylic acid in anhydrous alcoholic medium with a ratio of 1.2: 1, i.e. 1,2 times the amount by weight of betaine versus aspirin
  • betaine will refer to glycine betaine anhydrous or -monohydrate
  • aspirin will refer to acetyl salicylic acid, salicycic acid, salts thereof, or mixtures thereof, both as described on page 1 herein, under Field of the Invention
  • acetylsalicylic acid is less than 80 mg and Betaines is at least three times by weight the amount of acetylsalicylic acid, salicylic acid, pharmaceutical derivatives thereof and mixtures thereof.
  • compositions comprising a betaine and aspirin in a formulation wherein the betaine and aspirin are formulated together preferably in a bilayered tablet, the aspirin being present in a first layer, and the betaine being present in a second layer in an amount at least three times by weight the amount of aspirin.
  • the tablet includes a core and a coating layer surrounding said core and wherein one of the betaine and aspirin is present in the core and the other is present in the coating layer surrounding the core and one or more of the Betaines and aspirin are formulated as a controlled release formulation.
  • the tablet includes a core constituted by aspirin and/or its pharmaceutically acceptable derivatives and a coating layer surrounding said core wherein one or more of the Betaines is present and formulated as a controlled release formulation.
  • betaine antithrombotic properties it have appears that administrating the pharmaceutical combination of the invention allows to substantively reduce the amount of acetylsalicylic acid while achieving a significant therapeutic effect.
  • betaine and acetylsalicylic acid act in a synergistic manner with a good therapeutic effect in various pathologies such as blood flow disturbances, thrombo-embolism, inflammation and cancer.
  • the invention relates thus among others to:
  • aspirin for reducing the risk of a myocardial infarction
  • betaine for preventing or treating atherosclerosis and cardiovascular disease and cerebrovascular disease
  • Aspirin is known for causing gastrointestinal bleeding when used for long-term therapy. It is therefore desirable in long-term aspirin therapy that the aspirin is provided in a form and an amount which minimizes side effects.
  • the aim of the present invention is to lower the aspirin amount needed to achieve a therapeutically effect when combining aspirin with betaine. Due to betaine antithrombotic properties the two drugs act in a synergistic manner for a powerful effect. Moreover betaine reduces aspirin induced side effects as haemorrhage and gastrointestinal damages.
  • the combination of the invention may be useful for long term therapies as vascular occlusive diseases, inflammation, cancer and diabetes and aging related pathologies.
  • Glycine betaine anhydrous or -monohydrate in the context of the present invention is used in combination with acetylsalicylic acid, salicylic acid, pharmaceutical salts thereof for various clinical applications, such as: coronary thromboses and venous thromboses
  • compositions of the invention which includes a combination of a betaine and aspirin is effective in preventing, reducing and/or treating atherosclerosis, cardiovascular events and disease including coronary events and cerebrovascular events, and coronary artery disease and/or cerebrovascular disease, cancer, inflammation, diabetes and troubles related to aging.
  • cardiac event(s) and cardiac disease refer to coronary and/or cerebrovascular event(s) and disease including primary myocardial infarction, secondary myocardial infarction, myocardial ischemia, angina pectoris (including unstable angina), congestive heart failure, sudden cardiac death, cerebral infarction, cerebral thrombosis, cerebral ischemia, transient ischemic attack and the like.
  • CAD coronary artery disease
  • cancer cardiovascular disease
  • atherosclerosis of the intracranial and/or extracranial arteries, cerebral infarction, cerebral thrombosis, cerebral ischemia, stroke, and/or transient ischemic attacks.
  • Lipidic betaines and “betaine lipids”, which are not part of the claimed invention, refer to betaine lipids which are structural components of membranes commonly found in ferns, mosses, fungi, amoeba, eukaryotes such as nonseed plants and algae. Betaine lipids are ether-linked, nonphosphorous glycerolipids that resemble the more commonly known phosphatidylcholine in overall structure. Most common glycerolipids are containing a diacyl-glycerol moiety to which a polar head group is attached.
  • This head group can be a carbohydrate moiety as in the very abundant plant galactolipids or a phosphorylester as in the glycerophospholipids, the most common lipid class in animals.
  • Betaine lipids represent a third class of glycerolipids in which a quaternary amine alcohol is bound in an ether linkage to the diacylglycerol moiety. They can be obtained by extraction, by biosynthesis or by synthesis.
  • the betaine lipid diacylglyceryl- O -4' - (N, N, N- trimethyl)homoserine and a closely related isoform diacylglyceryl - O -2' - (hydroxymethyl) (N, N, N- trimethyl)- ⁇ -alanine are the most common.
  • Aspirin will preferably be employed in the form of salicylic acid acetate also referred to as acetylsalicylic acid.
  • salicylic acid may be employed.
  • Platelet aggregation is an essential event in the formation of blood clot and thrombus.
  • blood clots prevent blood losses by closing the opening.
  • the formation of a blood clot can reduce partly or completely the blood circulation, with the consequence of a cellular necrosis.
  • the platelet aggregation and thus the thrombosis at the level of the atherosclerosis plaques is an important factor for the genesis of conditions such as angina pectoris, myocardium infarct and vessel occlusion following a thrombolysis or an angioplasty.
  • Patients suffering a heart attack are treated with thrombolytic agents such as plasmin activators and the streptokinases which dissolve the fibrin from the clots.
  • thrombolytic agents such as plasmin activators and the streptokinases which dissolve the fibrin from the clots.
  • a major complication of this therapy is the reocclusion of vessels due to platelet aggregation, which can lead to irreversible damages to the heart, the brain or other organs.
  • Thrombosis starts with the adhesion of platelets at the vascular lesion sites.
  • the platelet adhesion is initiated by the receptor located at the surface of the platelets which bind to proteins of the extracellular cellular matrix of the exposed endothelium, such as fibrinogen, fibronectin, Von Willebrand factor, as well as other adhesive proteins such as vibronectin, collagen and laminin.
  • the activation of platelets is a reply to agonists such as epinephrine, ADP, collagen, the arachidonic acid or the thrombin. This activation leads to the activation of the glycoprotein Ib receptor (GP Ib) and/or of the glycoprotein IIb IIIa receptor (GP IIb IIIa) at the surface of the platelets.
  • GP Ib glycoprotein Ib receptor
  • GP IIb IIIa glycoprotein IIb IIIa receptor
  • This receptor(s) (GP Ib and/or GP IIb IIIa) is/are then available for its/their binding to fibrinogen and the platelet aggregation.
  • the adhesion of the receptor (GP IIb IIIa) to other adhesive proteins such as the Von Willebrand factor also leads the attachment of platelets between them and their aggregation.
  • the adhesion of molecules such as fibrinogen or the Von Willebrand factor to the receptor (GP IIb IIIa) leading the platelet aggregation is an essential step in the formation of the thrombus.
  • the receptor (GP IIb IIIa ) is thus a privileged target for the new therapy treating thrombosis and thromboembolic pathologies.
  • a subject matter of the present invention is to propose a molecule, especially a well-known and used molecule of vegetal origin, having this antagonist activity for the glycoprotein IIb IIIa receptor, while not having toxic characteristics.
  • vitronectin receptor improves the cell migration and provides regulating signals of the cell proliferation and cell differentiation, and activates the effects of insulin ( Ruoslahti, Kidney Int., 1997, 51, 1413-1417 ).
  • the regulation of the vitronectin receptor is associated with pathological conditions, such as vascular restinosis ( Clemetson and Clemetson, Cell.Mol. Life Sci., 1998,54,502-513 ), bone excess resorbtion ( Rodan and Rodan, J. Endocrinol., 1997, 154 Suppl, S47-56 ), and the angiogenesis process during the malignant melanomas ( Cheresh, Cancer Metastasis Rev., 1991, 10,3-10 ).
  • betaines have an antagonist activity for one or more glycoprotein(s) receptors, such as the glycoprotein Ib receptor and the glycoprotein IIb IIIa receptor, by inhibiting the platelet aggregation induced by various agonists.
  • This antagonist activity is not restricted to the glycoprotein site IIb IIIa but to all glycoprotein sites implicated in the cell adhesion of various origins, there between.
  • betaines when combined to acetylsalicylic acid act in a synergistic manner in different pathologies. This synergistic activity permit to lower the aspirin amount needed to achieve a therapeutically effect.
  • Platelets are activated by some agonists, whereby their forms, as well as their secretions of their granules can be modified, and whereby the aggregation thereof can be induced and the formation of clots and thrombi can be produced.
  • the present used platelet aggregation inhibitors are acting only on a single agonist.
  • aspirin is active against the arachidonic acid
  • ticlopidin is active against ADP
  • hirudin is active against thrombin.
  • the Betaines of the invention disclosed here before are actives against various agonists, as well as on fibrinogen, fibronectin, Von Willebrand factor and other adhesive proteins such as P-selectin, vitronectin, collagen, laminin families and lectin families. This is a major improvement for their efficiency, while preserving the haemostasis mechanism so as to avoid haemorrahgic or bleeding events. Due to their activity by oral administration, said compounds are excellent candidates for pathologies with adhesion of cells between them.
  • anhydrous glycine betaine can be administered, or glycine betaine monohydrate.
  • Acetylsalicylic acid, salicylic acid and pharmaceutically acceptable salts are known to have platelet antiaggregant properties.
  • the daily dose for ensuring a safe anti-aggregation for human with a weight of 70kg is at least 75 to 500 mg acetylsalicylic acid/ day.
  • High daily dose causes high bleeding risks, whereby requiring monitoring patients, due in particular to haemorrhage-related problems which can arise during or after medication.
  • With respect to low doses it is also required to monitor the patients so as to check that the low doses are effective for ensuring the required platelet anti-aggregation. It is not possible for the moment to determine before the treatment is made whether the low dose of aspirin will be sufficient for a patient. For theses reasons, patients requiring an administration of aspirin as platelet antiaggregant receive daily doses of at least 125 mg.
  • the invention relates thus to a pharmaceutical combination as a unitary dose comprising at least:
  • the pharmaceutical combination is for example suitable for a four times a day administration or preferably for a daily administration. (advantageously a two times a day administration, preferably an once day administration).
  • the invention as claimed is limited to oral formulations.
  • the combination comprises an amount of said first compound, calculated as acetylsalicylic acid, of less than 80 mg, advantageously of less than 60 mg, preferably of less than 40 mg, even if said combination is administered as a daily administration in one or more doses.
  • the combination comprises an amount of acetylsalicylic acid corresponding to 5 to 80 mg, advantageously from 10 to 75 mg, preferably from 15 to 75 mg calculated as acetylsalicylic acid.
  • Specific examples of combination comprise 10, 15, 20, 25,30,40,50 and 70 mg of acetylsalicylic acid.
  • the amount of second compound is at least 5, advantageously at least 10 times the amount, calculated as acetylsalicylic acid weight, of said first compound, preferably at least 20 times the amount, calculated as acetylsalicylic acid, of said first compound.
  • the amount of second compound in the combination is 30, 40, 50, 70, 85, 100 times the amount, calculated as acetylsalicylic acid, of said first compound.
  • the combination is prepared at least from a mixture in which at least 50% by weight of the first compound and at least 50% of the second compound are in soluble form.
  • the combination is prepared at least from a mixture in which at least 90% by weight of the first compound and at least 90% of the second compound are in soluble form, most preferably from a mixture in which the first compound and the second compound are substantially completely in soluble form. This is advantageous for ensuring a homogeneous dispersion of the active compounds in the batch used for the preparation of the unit dose.
  • the combination of the invention is advantageously at least a controlled release combination for the second compound and/or at least an immediate release combination for the first compound.
  • the combination is a controlled release formulation for at least a part of the second compound and a substantially immediate release formulation for the first compound.
  • the combination is for example a formulation enabling an immediate release for the first compound and for an amount of the second compound corresponding to two to ten times the amount of the first compound, and enabling a controlled release for an amount of second compound corresponding to more than 5, (preferably more than 10, most preferably more than 20) times the amount of first compound.
  • the weight ratio amount of second compound in a controlled release form / amount of second compound in an immediate release form is for example comprised between 5:1 and 75:1, preferably between 10:1 and 50:1.
  • the first compound can also be partly in a form suitable for a controlled release.
  • the combination is a formulation ensuring a first immediate release of an amount of second compound, then an immediate release of the first compound, and thereafter a controlled release of an larger amount of second compound.
  • the weight ratio amount of second compound in a controlled release form /amount of second compound in an immediate release form is for example comprised between 5:1 and 75:1, preferably between 10:1 and 50:1.
  • Immediate release form means in the present specification a form from which an active compound is released in the body so as to be bioavailable, less than 30 minutes after administration, advantageously less than 15 minutes after administration.
  • Controlled release form means in the present specification a form from which the release of an active compound is controlled during the time, such as delayed release and/or extended release.
  • the controlled release form is a form suitable for ensuring a minimum active agent concentration in the blood during at least 4 hours, advantageously during at least 6 hours, preferably during at least 8 hours, most preferably during 12 hours or more than 12 hours , such as during 24 hours or more.
  • the combination comprises dry particles, especially micro particles, prepared by drying a mixture in which the first compound and the second compound are partly in a soluble form.
  • the first compound is homogeneously dispersed in the second compound, whereby enabling a simultaneously release of the first compound and of the second compound.
  • the first compound and the second compound can also be combined in the form of a matrix and or in the form of a mixture of dry particles and/or in the form of a suspension, solution, etc.
  • the solution can be absorbed in porous carrier, such as porous matrix, porous solid particles, etc.
  • the porous carrier containing the solution of first and second compounds can then be coated with a layer, such as an enterosoluble film layer, a gastric soluble layer, a controlled release layer, a layer for ensuring an extended release or a delayed release.
  • the porous carrier containing the solution of first compound and second compound can be submitted to treatment, such as heat treatment for ensuring a deposit of first compound and/or second compound in the pores or on surface of the pores and/or for increasing the viscosity of the solution in the pores.
  • porous carrier containing the first and second compound in soluble form or in a substantially soluble form is that the release of first compound and second compound from the porous carrier occurs in the form of a solution, whereby facilitating the bioavailability of the active agent.
  • the porous carrier has for example a mean particle size of less than 5000 ⁇ m, such as less than 2000 ⁇ m, advantageously less than 1000 ⁇ m, for example a size comprised between 100 ⁇ m and 800 ⁇ m, such as an average particle size of 200 ⁇ m, 300 ⁇ m, 400 ⁇ m, 500 ⁇ m,600 ⁇ m, 700 ⁇ m and 750 ⁇ m.
  • the average pore diameter or average pore opening size is sufficient for enabling an easy passage of the solution into the pores, such diameter or size being for example lower than 20 ⁇ m, such as lower than 10 ⁇ m, advantageously lower than 2 ⁇ m, preferably in average (average in number or average in volume) lower than 1 ⁇ m, such as comprised between 5nanometer and 750nanometer, for example between 20nanometer and 600nanometer.
  • the average size in volume can be estimated as being equal to (4 x total volume of the pores or porosity)/ (surface or specific surface). According to a specific embodiment, the average size in volume is determined by taking into account the pore volume formed by pore with a diameter or size greater than 2 nanometers, advantageously greater than 5 nanometers, and the specific surface or BET surface of the pores with a diameter or size greater than 2 nanometers, advantageously greater than 5 nanometers.
  • the combination further comprises at least one compound reacting in presence of water so as to prepare a substantially immediate solution of first compound and second compound.
  • the combination is an effervescent combination enabling the preparation of an aqueous solution containing the first and second compounds, in a very short time, substantially immediately, advantageously substantially without mechanical shaking.
  • the invention relates also to a pharmaceutical unit dose comprising at least a pharmaceutical combination containing at least:
  • the combination is prepared from a mixture in which the first compound and the second compound are partly in a soluble form
  • the pharmaceutical unit dose comprises less than 100 mg, advantageously less than 80 mg (such as less than 75 mg, preferably less than 50mg) of said first compound expressed as acetylsalicylic acid, and in which the amount of second compound is at least five times the amount, calculated as acetylsalicylic acid weight, of said first compound.
  • the combination of said unit dose is advantageously prepared from a mixture in which at least 50% by weight of the first compound and at least 50% of the second compound are in soluble form, preferably from a mixture in which at least 90% by weight of the first compound and at least 90% of the second compound are in soluble form, most preferably from a mixture in which the first compound and the second compound are substantially completely in soluble form.
  • the combination is for example in the form of dry particles, especially micro particles, prepared by drying a mixture in which the first compound and the second compound are partly in a soluble form.
  • a combination as an oral unit dose wherein the first compound is in a form of a core in the form of dry particles, especially micro particles prepared by drying acetylsalicylic acid, salicylic acid, and mixtures thereof, and a second compound partly or completely in a soluble form selected from the group consisting of betaines, as defined previously said second compound in a amount at least five times by weight the amount of the first compound and partially or completely making a coating for the first compound.
  • the combination of the pharmaceutical unit dose of the invention can have one or more characteristics of the combination of the invention as disclosed here above.
  • the invention further relates to a kit for a daily administration, said kit comprising at least:
  • the first oral formulation comprises an amount of said first compound, calculated as acetylsalicylic acid, of less than 85 mg, advantageously of less than 75 mg, preferably of less than 60 mg.
  • the first oral formulation comprises an amount of acetylsalicylic acid corresponding to 5 to 80 mg, advantageously from 10 to 75 mg, preferably from 15 to 75 mg calculated as acetylsalicylic acid.
  • the second oral formulation comprises an amount of second compound corresponding to at least 10 times the amount, calculated as acetylsalicylic acid, of said first compound.
  • the kit is for example two distinct oral formulations to be administered successively immediately or to be administered at different moment of the day.
  • the first oral formulation is administered, while at midday and/or in the afternoon and/or in the evening a second oral formulation is administered.
  • the kit can thus comprise more than two oral formulations to be administered during a day.
  • the first oral formulation can contain an amount of a second compound (different from the first compound), while the second oral formulation can contain an amount of a first compound (different from the second compound).
  • the first oral formulation and the second oral formulation are substantially identical or similar.
  • the second oral formulation has a higher content of second compound and is poor in first compound.
  • the kit can comprise more than 2 oral formulations, for example three, four, etc oral formulations for administering a one day dose.
  • the oral formulations of a kit can be administered in different forms. For example a first oral administration to be taken as a dry formulation (tablet, pills, etc), while the second administration has to be taken as a syrup, solutions, etc.
  • the second oral formulation and/or third oral formulation comprise an amount of second compound corresponding to at least 20 times the amount, calculated as acetylsalicylic acid, of said first compound.
  • the first oral formulation comprises also an amount of a second compound selected from the group consisting of betaines as defined previously
  • the first oral formulation is prepared at least from a mixture in which at least 50% by weight of the first compound and at least 50% of the second compound are in soluble form, advantageously at least from a mixture in which at least 90% by weight of the first compound and at least 90% of the second compound are in soluble form, preferably at least from a mixture in which the first compound and the second compound are substantially completely in soluble form.
  • the second oral formulation is at least a controlled release formulation for the second compound.
  • the first oral formulation is at least an immediate release formulation for the first compound and possibly for an amount of the second compound.
  • the first administration is an oral administration of an oral formulation which is substantially an immediate release formulation for the first compound and for an amount of second compound different from the first compound (for example comprised between 0.5 and 10 times the amount of first compound, advantageously comprised between 1 and 5 times the amount of the first amount) and which is advantageously a controlled release for an amount of the second compound (for example release controlled for more than 8 hours, such as release controlled for 10 hours, 12 hours or even more), while the second oral formulation (for example to be taken 12 hours after the administration of the first oral formulation) is at least a controlled release formulation for the second compound (for example release controlled for more than 8 hours, such as release controlled for 12 hours, 24 hours or even more), said second oral formulation being preferably substantially free of first compound.
  • an oral formulation which is substantially an immediate release formulation for the first compound and for an amount of second compound different from the first compound (for example comprised between 0.5 and 10 times the amount of first compound, advantageously comprised between 1 and 5 times the amount of the first amount) and which is advantageously a controlled release for an amount of
  • the invention relates also to a pharmaceutical kit comprising at least one pharmaceutical combination of the invention or one pharmaceutical unit dose according to the invention , and a second pharmaceutical unit dose containing as active agent at least a compound selected from the group consisting of betaines as defined previously, with the provision that said second unit dose is free of compound selected among the group consisting acetylsalicylic acid, salicylic acid.
  • the invention further relates to a treatment of a patient in need for treating or for preventing thrombosis troubles for a patient, by administering to said patient a pharmaceutical combination according to the invention or a pharmaceutical unit dose according the invention, in which advantageously before and/or during and/or after said administration, a therapeutic effective amount of glycine betaine is administered to said patient for preventing or reducing the haemorrhagic side effect.
  • Acetylsalicylic acid, salicylic acid, and Betaines are administered orally, by tablets, capsules, syrup, etc.
  • Administered doses can vary from 0.001g to 1 g per kg live body, for example from 0.005 g to 0,5 g, in particular from 0.01 g to 0,3 g per kg life body.
  • administration forms are: tablets, capsules, releasing forms, sublingual administration form, powder (for example for buccal inhalation), syrup, solution (nebulization, for example for buccal inhalation).
  • dosage form entero soluble oral dosage form, such as gastro
  • insoluble tablets or capsules, etc. provided with an entero soluble coating or matrix or system.
  • the pharmaceutical combination can be in the form of a kit, so as to prepare the combination before administration or during the administration.
  • a betaine as defined previously
  • ...twelve-hourly e.g. up to twenty-four hourly or even more, such as for a week, two weeks, one month, three months
  • a pharmaceutical composition which includes a betaine and aspirin, which provides for maximum patient benefits including maximum reduced risk of a myocardial infarction with minimal physical and chemical incompatibility (including minimal betaine/aspirin interaction), and reduced side effects normally associated with use of aspirin.
  • a treatment for preventing or inhibiting or treating atherosclerosis, and/or reducing risk of or treating a cardiovascular event or disease including coronary artery disease and cerebrovascular disease, wherein a pharmaceutical composition containing a combination of a betaine and aspirin in a single dosage form, in a manner so as to minimize interaction of the betaine and aspirin, is administered to a patient in need of treatment.
  • a pharmaceutical composition wherein the betaine and aspirin are formulated together in a single tablet.
  • the tablet of the invention is preferably in the form of a bilayered tablet which includes a first layer and a second layer.
  • Aspirin in the form of granules of preselected size will be present in the first layer together with optional excipients as described hereinafter, while the betaine will be present in the second layer which optionally may include one or more buffering agents (as necessary to prevent undesirable betaine/aspirin interaction) and optionally one or more excipients as described hereinafter.
  • the betaine will be present in the second layer optionally in a slow and/or controlled release form.
  • the bilayered tablet of the invention may include an outer protective coating or finishing layer as described hereinafter.
  • the bilayered tablet of the invention may include further another therapeutically active agent.
  • the bilayered tablet of the invention may include further another therapeutically active agent as listed in the application PCT/BE 02/ 00013 of the one of the applicants.
  • Another embodiment of the present invention comprises a cored tablet which includes a core and a buffering layer or outer coat which can be compressed onto the core as a dry coat.
  • the core will preferably include compressed aspirin granules while the buffering layer or outer coat will include a betaine together with one or more buffering agents and optional excipients.
  • Provision of aspirin in the core and betaine in the buffering layer will effectively reduce the aspirin dose needed, reduce its side effects and also minimize drug incompatibilities while providing maximum efficacy.
  • the so-described cored tablet may also optionally include an outer protective coating or finishing layer as described hereinafter.
  • a pharmaceutical composition which is in the form of a tablet or capsule which includes a mixture of aspirin granules having an enteric coating and particles or granules of a betaine.
  • a pharmaceutical composition will provide maximum efficacy while minimizing side effects resulting from prolonged aspirin therapy.
  • enteric coated aspirin granules as described above may be further coated with a protective coating or finishing layer.
  • the double coated particles of aspirin can be mixed with Betaines as defined previously powders or granules, and the mixture can be encapsulated or tableted as described herein. This combination will protect the integrity of the enteric coat and minimize the side effects normally resulting from prolonged aspirin therapy.
  • the aspirin and the betaine granules do not need to be mixed together; these can even be encapsulated separately into the same capsule shells in two shots.
  • composition of the invention includes granules of enteric coated aspirin and enteric coated betaine, in the same dosage form such as compressed tablets or capsules.
  • the tablets containing the enteric coated granules of aspirin and betaine may also include an outer protective coating or finishing layer.
  • the composition of the invention may comprise a mixture of aspirin granules and betaine (including enteric coated particles of betaine or particles of betaine, containing an outer protective coating or finishing layer); the above mixture may take the form of compressed tablets or capsules (where the mixture can be encapsulated separately in two shots in the same capsule shells).
  • composition of the invention in the form of a tablet or capsule will include aspirin in amounts of less than 100mg.
  • the aspirin for use in forming the pharmaceutical composition of the invention will preferably be in the form of granules having an average particle size within the range from about 10 ⁇ m to about 2 mm, more preferably from about 0.25 mm to 1.0 mm.
  • the pharmaceutical composition of the invention will contain a Betaine as defined previously in an amount as normally employed for such betaine as exemplified in the patents thus, depending upon the particular betaine, it may be employed in amounts within the range from about 0.1 mg to 20000 mg per day in single or divided doses, and preferably from about 0.2 to about 10000 mg per day. Most preferably for betaine, a daily dosage in single or divided doses of 100 to 5000 mg, such as 300mg, 500mg, 750mg, 1000mg, 1500mg, 2000mg, 3000mg may be employed.
  • the first layer containing aspirin will also preferably include bulking agents such as lactose, microcrystalline cellulose, wood cellulose, corn starch, modified corn starch, calcium phosphate, sugar, dextrose, mannitol or sorbitol.
  • the bulking agent will be present in an amount from about 1 to about 90%, preferably from about 5 to about 85% by weight of the first layer containing aspirin.
  • the first layer may also include a tabletting lubricant, such as zinc stearate, magnesium stearate, calcium stearate, talc, carnauba wax, stearic acid, palmitic acid or hydrogenated vegetable oils and fats, in an amount within the range from about 0.01 to about 4%, and preferably 0.02 to about 2% by weight of the first layer.
  • a tabletting lubricant such as zinc stearate, magnesium stearate, calcium stearate, talc, carnauba wax, stearic acid, palmitic acid or hydrogenated vegetable oils and fats
  • the second layer of the bilayered tablet containing betaine will usually include a bulking agent such as lactose, microcrystalline cellulose, modified corn starch, calcium phosphate or other bulking agent as set out above for the first layer, in an amount within the range from about 1 to about 90%, preferably from about 5 to about 85% by weight of the second layer.
  • a bulking agent such as lactose, microcrystalline cellulose, modified corn starch, calcium phosphate or other bulking agent as set out above for the first layer, in an amount within the range from about 1 to about 90%, preferably from about 5 to about 85% by weight of the second layer.
  • the second layer may include a binder such as corn starch, pregelatinized starch, polyvinyl pyrrolidone (PVP), hydroxypropylmethyl cellulose (HPMC), ethyl cellulose, cellulose acetate and the like, in an amount within the range from about 0.5 to about 20%, preferably from about 1 to about 10% by weight of the second layer, and a tabletting lubricant such as magnesium stearate, zinc stearate, or other lubricant as set out above with respect to the first layer in an amount from about 0.01 to about 4%, preferably from about 0.02 to about 2% by weight of the second layer.
  • a binder such as corn starch, pregelatinized starch, polyvinyl pyrrolidone (PVP), hydroxypropylmethyl cellulose (HPMC), ethyl cellulose, cellulose acetate and the like, in an amount within the range from about 0.5 to about 20%, preferably from about 1 to about 10% by weight of the second layer, and
  • the buffering agents present in the second layer may include conventional acid buffers such as calcium carbonate, magnesium oxide, magnesium carbonate, magnesium hydroxide, aluminum hydroxide, dihydroxyaluminum sodium carbonate, aluminum magnesium hydroxide sulfate or aluminum hydroxide magnesium carbonate co-dried gel, or mixtures of one or more thereof, in amounts as needed to insure that the aspirin will be sufficiently buffered to inhibit GI side effects.
  • amounts of buffering agent within the range from about 10 to about 1000 mg, preferably from about 50 to about 500 mg will be employed depending upon the amount of aspirin present in the first layer.
  • the first layer containing aspirin may be prepared by conventional wet granulation or dry granulation (compaction) techniques.
  • the second layer containing betaine and buffers may be prepared by conventional wet granulation or dry granulation (compaction) techniques.
  • the first and second layers may then be compressed and combined to form a bilayered tablet employing conventional bilayer tabletting equipment.
  • compositions which may optionally be present in either of the two layers include preservatives, stabilizers, anti-adherents or silica flow conditioners or glidants, such as Syloid brand silicon dioxide as well as antioxidants such as Vitamin E, Vitamin C, and folic acid, Vitamin B.sub.6 and Vitamin B.sub.12.
  • the bilayer tablet of the invention may also include an outer protective coating layer which may comprise from 0 to about 15% by weight of the bilayer tablet.
  • the outer protective coating layer which is applied over the bilayered tablet may comprise any conventional coating formulations and will include one or more film-formers or binders, such as a hydrophilic polymer like hydroxy-propylmethyl cellulose (HPMC) and a hydrophobic polymer like ethyl cellulose, cellulose acetate, polyvinyl alcohol-maleic anhydride copolymers, acrylic copolymers, beta.-pinene polymers, glyceryl esters of wood resins and the like, and one or more plasticizers, such as polyethylene glycol, triethyl citrate, diethyl phthalate, propylene glycol, glycerin, butyl phthalate, castor oil and the like.
  • plasticizers such as polyethylene glycol, triethyl citrate, diethyl phthalate, propylene glycol, g
  • the film formers are applied from a solvent system containing one or more solvents including water, alcohols like methyl alcohol, ethyl alcohol or isopropyl alcohol, ketones like acetone, or ethylmethyl ketone, chlorinated hydrocarbons like methylene chloride, dichloroethane, and 1,1,1-trichloroethane.
  • solvents including water, alcohols like methyl alcohol, ethyl alcohol or isopropyl alcohol, ketones like acetone, or ethylmethyl ketone, chlorinated hydrocarbons like methylene chloride, dichloroethane, and 1,1,1-trichloroethane.
  • the pharmaceutical composition of the invention in the form of a cored tablet wherein the aspirin forms the core, and betaine plus buffering agent are present in a surrounding coat layer may be prepared employing conventional cored tablet technology.
  • the aspirin containing core including excipients and other ingredients as described for the first layer in the bilayered tablet of the invention
  • the buffering layer containing betaine as well as excipients and other ingredients may be compressed onto the core as a dry coat.
  • the so-formed cored tablet may be coated with an outer protective coating layer as described above for the bilayered tablet.
  • composition of the invention is formed of tablets or capsules containing a mixture of enteric coated aspirin granules, and a betaine may be in the form of a tablet or capsule.
  • the aspirin granules can be coated with conventional enteric polymers coatings in aqueous or non-aqueous systems.
  • enteric polymers coatings for example, Eudragit L-30D-55 (acrylic acid copolymers-Rohm Pharma) (5 to 25% solids) containing 10 to 15% of diethylphthlate (w/w) as plasticizer can be used in an aqueous system.
  • enteric polymer coating systems may be employed such as Eudragit R and S series resins, (acrylic acid copolymers-Rohm Pharma), cellulose acetate phthalate, hydroxypropylmethyl cellulose phthalate, hydroxypropylmethylcellulose acetate succinate, cellulose acetate maleate, cellulose acetate succinate and the like, and a suitable plasticizer such as triethyl citrate, diethyl phthalate, tributyl citrate, triacetin, dibutyl phthalate, dibutyl sebicate, Myvacet 940, and other commonly used plasticizers as may be suitable for particular enteric polymers can be used. It will be appreciated that any polymer with suitable plasticizer can be used in aqueous or non-aqueous system to form an enteric coating on the aspirin granule or particle.
  • suitable plasticizer such as triethyl citrate, diethyl phthalate, tributyl citrate, triacetin, dibutyl
  • the enteric coated aspirin granules described above may be further coated with an outer protective finishing coat or layer as described hereinbefore.
  • the double coated aspirin granules can be mixed with a betaine such as Betaines powders or granules and the mixture can be encapsulated or tableted as described above.
  • aspirin is enteric coated as described above and the betaine can optionally be enteric coated.
  • the Betaines can be coated in the form of pure drugs or after spheronization or agglomeration. The particles for coating do not need to be perfectly spherical. These could be rods or irregular particles.
  • the enteric coated particles of the two drugs can be tableted or encapsulated together. As described above, appropriate excipients (fillers, binders, disintegrants, and lubricant, etc.) can be used to facilitate tabletting. This betaine/aspirin combination will minimize side effects of aspirin, and eliminate chemical incompatibility.
  • aspirin side effects are not an issue, especially at lower (e.g., 80 mg) aspirin dosages, then aspirin granules (including uncoated aspirin) can be mixed with betaine powder or granules for tabletting or for encapsulating.
  • aspirin granules can be mixed with enteric coated particles of betaine and the mixture can be tableted or encapsulated or the two granules can be encapsulated in two shots in the same capsule shells.
  • the pharmaceutical composition of the invention containing the combination of the betaine and aspirin may be administered to mammalian species, such as monkeys, dogs, cattle, livestock, cats, rats, humans, etc., and, as described hereinbefore, may be incorporated in a tablet or capsule.
  • mammalian species such as monkeys, dogs, cattle, livestock, cats, rats, humans, etc.
  • the above dosage forms will also include the necessary carrier material, excipient, lubricant, buffer, antibacterial, bulking agent (such as mannitol), anti-oxidants such as Vitamin C and Vitamin E, as well as Vitamin B.sub.6, Vitamin B.sub.12, folic acid, sodium bisulfite, and the like.
  • the dose administered must be adjusted according to age, weight and condition of the patient, as well as the route of administration, dosage form and regimen and the desired result.
  • compositions described above may be administered in the dosage forms as described above in single or divided doses of one to four times daily. It may be advisable to start a patient on a low dose combination and work up gradually to a high dose combination.
  • Tablets of various sizes can be prepared, e.g., of about 2 to 2000 mg in total weight, containing the active substances in the ranges described above, with the remainder being a physiologically acceptable carrier of other materials according to accepted pharmaceutical practice. These tablets can, of course, be scored to provide for fractional doses in some cases. Gelatin capsules can be similarly formulated.
  • Liquid formulations can also be prepared by dissolving or suspending one or the combination of active substances in a conventional liquid vehicle acceptable for pharmaceutical administration so as to provide the desired dosage in one to four teaspoonsful.
  • Such dosage forms can be administered to the patient on a regimen of one to four doses per day.
  • compositions as described herein, the active substances, in the amounts described above, are compounded as described herein (according to accepted pharmaceutical practice) with a physiologically acceptable vehicle, carrier, excipient, binder, preservative, stabilizer, flavor, etc., in the particular type of unit dosage form.
  • excipients which may be incorporated in tablets are the following: a binder such as gum tragacanth, acacia, corn starch or gelatin; an excipient such as dicalcium phosphate or cellulose; a disintegrating agent such as corn starch, potato starch, alginic acid, sodium starch glycolate or the like; a lubricant such as stearic acid, zinc stearate or magnesium stearate; a sweetening agent such as sucrose, aspartame, lactose or saccharin; a flavoring agent such as orange, peppermint, oil of wintergreen or cherry.
  • a binder such as gum tragacanth, acacia, corn starch or gelatin
  • an excipient such as dicalcium phosphate or cellulose
  • a disintegrating agent such as corn starch, potato starch, alginic acid, sodium starch glycolate or the like
  • a lubricant such as stearic acid, zinc stearate or magnesium
  • the dosage unit form When the dosage unit form is a capsule, it may contain in addition to materials of the above type a liquid carrier such as a fatty oil. As indicated, various other materials may be present as coatings or to otherwise modify the physical form of the dosage unit. For instance, tablets or capsules may be coated with shellac, sugar or both.
  • a syrup of elixir may contain the active compounds, water, alcohol or the like as the carrier, glycerol as solubilizer, sucrose as sweetening agent, methyl and propyl parabens as preservatives, a dye and a flavoring such as cherry or orange.
  • formulations as described above will be administered for a prolonged period, that is, for as long as the potential for cardiovascular events and disease including coronary artery disease and/or cerebrovascular disease remains or the symptoms continue.
  • Sustained release forms of such formulations which may provide such amounts daily, biweekly, weekly, monthly and the like may also be employed.
  • a dosing period of at least 10 days are required to achieve minimal benefit.
  • embodiments having an amount of second compound of less than 5 times the amount of first compound of the combinations as claimed do not form part of the claimed invention and are included for illustrative purposes only. The same applies to embodiments or examples featuring betaine instead of glycine betaine anhydrous or -monohydrate.
  • a bilayered tablet containing aspirin in a first layer and betaine in a second layer as described below may be prepared as follows.
  • the aspirin granulation in the first layer is blended with sufficient quantity of the lactose/microcrystalline cellulose granulation as necessary to bulk up in order to have sufficient granulation to compress a satisfactory layer.
  • the aspirin granules along with the bulking granules are blended with zinc stearate as a lubricant.
  • Zinc stearate can be replaced with other non-alkaline lubricants, i.e., Lubritab.®. or other high melting point hydrogenated powdered waxes
  • Ingredients in the second layer are wet granulated using starch paste or other wet granulating materials, for example, PVP or HPMC, or can be dry granulated by compaction.
  • the granules can be sized and lubricated.
  • the two tablet layers are compressed using appropriate conventional tools and a suitable bilayer tabletting press, to form the bilayered tablet of the invention.
  • the quantity of the buffering agents used in the second layer can be adjusted as necessary to minimize gastrointestinal side effects. It should be understood that these buffering agents can be replaced with other suitable buffering agents, if desired.
  • the so-formed bilayered tablets may be coated with HPMC (hydroxypropylmethylcellulose) or commercially available Opadry.®. clear or Dri Klear.®. (HPMC) or any of these with any desired color.
  • HPMC hydroxypropylmethylcellulose
  • HPMC hydroxypropylmethylcellulose
  • HPMC commercially available Opadry.®. clear or Dri Klear.®.
  • This coat is not limited to HPMC based coats only.
  • Polymers, i.e., Eudragit E30D (acrylic acid copolymer) and others can also be used to give the tablets a finishing coat.
  • Opadry.® is dispersed in water to prepare a dispersion of 10%-30% solids*. This dispersion is used for coating the above tablets using conventional coating equipment. The coating of 0.2%-2% or any desired level (based on the weight of the finished coated bilayered tablet) can be applied to the bilayered tablet employing conventional techniques. *Antifoam emulsion at a level of 0.1 to 2% of solids, can also be included in the formulation.
  • the so-formed tablets provide maximum benefits while minimizing drug interaction and other undesirable side effects.
  • betaine contained in the buffered layer of the bilayered tablet of the invention may be replaced with equivalent amounts of lipidic betaines and/or betaine lipids.
  • Tablets or capsules containing enteric coated aspirin and a betaine, which preferably is anhydrous betaine, monohydrate betaine, having the following composition are prepared as described below.
  • Aspirin particles are coated with enteric polymers in aqueous or non-aqueous systems.
  • Eudragit L-30D-55 containing 10%-15% of diethyl phthalate (w/w) is used in an aqueous system.
  • the coating suspension is prepared having solid contents of 10%-30%.
  • the aspirin particles are coated in a fluid bed coating system using a Wurster insert or with top spray coating, so that aspirin particles of enteric quality can be produced.
  • the enteric coated particles are mixed with betaine powders or granules and the mixtures are encapsulated or tableted using appropriate excipients (fillers, binder, disintegrants, and lubricants). Any of the listed betaine can be selected at its desired dose level along with the desired aspirin dose.
  • Betaines can also be granulated, and the betaine granules and the enteric coated aspirin granules can be filled separately into the same capsule shell.
  • Betaine granules can be prepared by dry or wet granulation processes, using suitable conventional excipients as is well known in the pharmaceutical field.
  • a cored tablet containing an aspirin core and a buffered coating thereon containing a betaine having the following composition is prepared as described below.
  • the aspirin granulation for the core is blended with sufficient quantity of the lactose/microcrystalline cellulose granulation as necessary to bulk up in order to have sufficient granulation to compress a satisfactory core.
  • the aspirin granules along with the bulking granules are blended with zinc stearate as a lubricant.
  • Zinc stearate can be replaced with other non-alkaline lubricants, i.e., Lubritab.®. or other high melting point hydrogenated powdered waxes.
  • Ingredients for the outer layer are wet granulated using starch paste or other wet granulating materials, for example, PVP or HPMC, or can be dry granulated by compaction.
  • the granules can be sized and lubricated.
  • the dry coated tablets can be compressed using appropriate tools and a suitable dry coating tabletting press.
  • the quantity of the buffering agents used in the outer layer can be adjusted as in Example 1. Other known buffering agents may be used as well.
  • the doses of 100 mg /kg and 50 mg /kg of aspirin used in these experiments are the doses known to be antithrombotic in rat in this model. Due to rat known resistance to aspirin these high doses are necessary and represent at least 10 to 25 fold the antithrombotic doses needed in other species in experimental thrombosis. Due to this specificity of rat the ratios betaine/aspirin used in these experiments don't reflect the ratio to be used in other species.
  • an orally daily dose of 75 to 300 mg, i.e. 1 to 5 mg/ kg is known to be antithrombotic. At this human dose (1 to 5 mg/ kg), betaine at 3 to 15 mg/kg or more, will be in accordance with the invention.
  • the rats are subjected to a fasting for 12 hours.
  • Betaine is subcutaneous injected one hour before blood sampling.
  • the rats are then anaesthetised with sodium Thiopental administered at a dose of 200 mg/Kg and the blood samples are taken by intracardiac puncture on a trisodium citrate solution (1 volume of solution at 3, 8 % citrate for 9 volumes of blood).
  • the tail of anaesthetised rat is dipped for 5 minutes in a water bath at 37°C so as to provoke a dilatation of the peripheral vessels which are removed and cut at the end, the chronometer being started.
  • the IHT is defined as being the time period comprised between the cutting of end tail and the end of the haemorrhage or bleeding.
  • the end of haemorrhage is defined as the time where the last drop of blood is removed from the tail and no other drop is seen during 180 seconds.
  • the substances were subcutaneously administrated 60 minutes prior to the tail cut.
  • lesion of the vascular wall is induced by a laser beam.
  • This beam causes a limited lesion of the vascular endothelium (only 1 to 2 cells are destroyed).
  • This laying bare of the sub-endothelium which is a thrombogenetic surface, results in the adherence of platelets via glycoproteins.
  • This adherence of platelets is followed by their activation, they form pseudopods and secrete the content of their granules.
  • This activation results in the appearance of glycoprotein binding sites which are necessary for the aggregation of the platelets between them and for platelet adhesion to the thrombogenic surfaces.
  • This lesion is induced in the mesenteric microcirculation of the rat. It is immediately followed by the formation of a thrombus (in a few seconds). This thrombus, which rapidly enlarges under the influence of the blood flow, embolises before being formed again.
  • the substances were subcutaneously injected 1 hour before the tests.
  • Betaine in combination with ASA had a little effect on induced haemorrhage. Surprisingly the combination shows better antithrombotic (more laser shoots & fewer emboli) effect than ASA alone, this being confirmed in the aggregation test. Betaine is potentialising aspirin effect, suggesting its possible activity on a different mechanism than aspirin. In this model the combination betaine / ASA showed better results than dipyridamole / aspirin combination suggesting a future clinical development.
  • Amplitudes are expressed in Ohm and Velocities in Ohm /min.
  • Betaine in combination with ASA had a significant effect on induced haemorrhage while preserving the antithrombotic effect.
  • the combination reducing by 2 times the therapeutic dose in rats (50 mg/kg instead of 100 mg/kg) shows better antithrombotic (more laser shoots & fewer emboli) effect than ASA alone at 100 mg/ kg, this being confirmed in the aggregation test.
  • the combination of the invention clearly allows to reduce the effective dose of aspirin while obtaining a significant improvement in the therapeutic effect.
  • Betaine is potentialising aspirin effect, suggesting its possible activity on a different mechanism than aspirin.
  • the two molecules act in a synergistic manner to prevent thrombosis in this model.
  • the combination betaine/ ASA showed better results than dipyridamole/ aspirin combination suggesting future clinical development.
  • treatment with asa/betaine combination completely inhibits the thrombo-embolic complications which are initiated by laser firings.
  • treatment with asa/betaine combination before laser firings decreases the vascular adherence of platelets and the aggregation thereof.
  • treatment with asa/betaine combination completely inhibits thrombo-embolic complications.
  • treatment with asa/betaine combination before the induction of thrombosis exhibited a high antithrombotic potential with regard to all the parameters involved in thrombus formation process.
  • this drug also exhibits anticoagulant, anti-aggregant and fibrinolytic indications.
  • the demonstrated innocuousness of this combination enables long-term treatments to be considered which do not necessitate biological monitoring.
  • asa/betaine combination acts at several levels of haemostatis, i.e. it acts on platelet aggregation, coagulation and fibrinolysis. This activity is durable and prevents repeated administration, which constitutes a considerable improvement in relation to existing treatments.
  • the administration of betaine/asa does not induce any haemorrahgic risk or other side effects (e.g. heparin-induced thrombopenia), which constitutes a major advance in antithrombotic therapy.
  • Amplitudes are expressed in Ohm and Velocities in Ohm /min.
  • Betaine in combination with ASA had a significant effect on induced haemorrhage.
  • the combination shows better antithrombotic (more laser shoots & fewer emboli) effect than ASA alone, this being confirmed in the aggregation test.
  • Betaine is potentialising aspirin effect, suggesting its possible activity on a different mechanism than aspirin.
  • the combination betaine / ASA showed better results than clopidogrel/ aspirin combination confirming that this new combination in that ratio may be useful for parenterally administration in future acute clinical situations (i.e. angioplasties, prosthesis, stents placement, hip surgery, prosthetic heart valves, arterial grafts and replacement surgery).
  • the synergistic effect of asa/betaine on platelet adhesion is studied by perfusing blood on thrombogenic surface such as collagen under shear stress conditions.
  • Citrated human aspirinized blood was pre-labelled with mepacrine and exposed to vehicle alone or betaine (20, 40, and 80 ⁇ g/ml) for 20 minutes before perfusion.
  • asa/betaine has been evaluated by performing experiments 60 dynes/cm 2 witch mimics arterial thrombosis. Before perfusion citrated whole blood was incubated with saline alone or betaine at concentration of 20, 40, and 80 ⁇ g /ml for 20 minutes and then perfused on collagen at 60 dynes /cm 2 . At the end of 2 minutes of perfusion, cells were fixed and the area covered by thrombi was calculated by analysis of fluorescent thrombus images acquired by confocal microscopy.
  • Collagen coated slides Glass slides were with collagen (200 ⁇ g/ml; equine collagen), placed for 1 hour in a water bath at 37°C, and the collagen gel allowed to evaporate for 30 minutes under a ventilated hood. Perfusion with citrated whole blood was started and continued for 2 minutes, then blood was withdrawn from the circuit, and platelet thrombi adherent to the collagen coated surface were fixed and stained with May Grunwald-Giemsa. Images of platelet thrombi were digitised using a light microscope connected to a computer-based image analysis system. The surface occupied by thrombi and mean thrombus area were evaluated by automatic edge detection using built-in specific functions of a software image. Platelet adhesion and thrombus formation .
  • Platelet adhesion assay was performed according to the described previously (Alevriadou et al.,1993; Boccardo et al.,1997) with minor modifications. Blood collected on citrate (3,8 %) was perfused through a flow chamber using a syringe pump. A flow chamber thermostatized to 37°C was used in which one surface of the perfusion channel is a glass slide coated with equine collagen.
  • the chamber dimensions (30 mm long, 1mm large, and 150 ⁇ m in the thickness) allow to obtain a wide range of shear rate low flow rates of blood.
  • Thrombus formation on collagen coated surface studied at the shear stress of 60 dynes /cm 2 in which Von Willebrand factor is involved shows a dose-dependent inhibitory activity of asa/betaine.
  • Thrombus formation of blood incubated with asa/betaine at 20 and 40 ⁇ g /ml was inhibited by 15 and 41 % respectively
  • the effect of betaine and asa/betaine added to non-stimulated blood perfused on collagen at high shear stress (60 dynes/cm 2 ) shows a dose-dependent inhibitory activity of asa/betaine.
  • aspirinized blood treated with betaine at the concentration of 80 ⁇ g/ml showed a significant reduction ( - 63 % ) in platelet deposition in respect to vehicle and a significant reduction in respect to aspirin alone (- 51 % ) and to betaine alone (- 27 % ).
  • Table 1 Subject saline betaine betaine betaine 20 ⁇ g/ml 40 ⁇ g/ml 80 ⁇ g/ml 1 100586 88746 66852 57544 2 145921 135241 92433 81585 3 165239 122369 89628 76654 4 175692 154425 95645 82579 Mean 146859 125195 86139 74590
  • the invention relates thus also to:
  • Aspirin will preferably be employed in the form of salicylic acid acetate also referred to as acetylsalicylic acid.
  • salicylic acid may be employed.
  • Salicylate salts may also be employed.
  • the combinations of the invention will be useful for the treatment of pain, inflammation, and fever rheumatoid arthritis, osteoarthritis, juvenile and adult forms of arthritis, gout, dysmenorrhea, muscle pains, and dental pain.
  • the modes, the methods, the combinations, the uses and the formulations as described in the application PCT/BE 02/00013 of one of the applicants are also suitable for the Betaines/ aspirin combinations when formulated or combined with antithrombotic, anti inflammatory, anti cancerous and anti diabetic drugs.
  • the modes, the methods, the combinations, the uses and the formulations as described in the application PCT/BE 02/00013 of one of the applicants are also suitable for the Betaines/ aspirin combinations when Betaines are formulated in a slow or controlled release forms.
  • the combinations of the invention may be useful for long term therapies as vascular occlusive diseases, inflammation, cancer and diabetes.

Claims (30)

  1. Une combinaison pharmaceutique orale comprenant au moins:
    - Un premier composé choisi parmi le groupe consistant en l'acide acétylsalicylique, acide salicylique et leurs sels pharmaceutiques, et
    - Un deuxième composé choisi parmi le groupe consistant en la glycine bétaine anhydre et la glycine bétaine monohydrate,
    dans laquelle ladite combinaison comprend moins de 100 mg dudit premier composé exprimé en acide acétylsalicylique, et
    dans laquelle la quantité du second composé est au moins 5 fois la quantité, calculée en poids d'acide acétylsalicylique, dudit premier composé.
  2. La combinaison de la revendication 1, qui comprend une quantité dudit premier composé, calculée en poids d'acide acétylsalicylique, de moins de 85 mg, avantageusement de moins de 75 mg, préférablement de moins de 60 mg.
  3. La combinaison de la revendication 1, qui comprend une quantité d'acide acétylsalicylique ou sel pharmaceutique de celui-ci correspondant à 3 à 80 mg, avantageusement de 5 à 75 mg, préférablement de 10 à 75 mg calculés en acide acétylsalicylique.
  4. La combinaison de la revendication 1, dans laquelle la quantité du second composé est comprise entre 5 et 25 fois la quantité calculée en poids d'acide acétylsalicylique dudit premier composé.
  5. La combinaison de la revendication 1, qui est préparée au moins à partir d'un mélange dans lequel au moins 50% en poids, préférablement au moins 90% en poids du premier composé et au moins 50% en poids, préférablement au moins 90% en poids du second composé sont dans une forme soluble.
  6. La combinaison de la revendication 1, dans laquelle le second composé est au moins sous une forme à libération contrôlée et/ou dans laquelle le premier composé est au moins partiellement sous une forme à libération immédiate.
  7. La combinaison de la revendication 1, dans laquelle le premier composé est au moins partiellement sous une forme à libération immédiate.
  8. La combinaison de la revendication 1, qui comprend des particules sèches, particulièrement des microparticules, préparées en séchant un mélange dans lequel le premier composé et le second composé sont partiellement sous une forme soluble.
  9. La combinaison de la revendication 1, dans laquelle le premier composé et le second composé sont combinés dans une forme choisie parmi le groupe consistant en une matrice, un gel, un hydrogel, une cire et un support poreux, une tablette bicouche et leur combinaison.
  10. Une forme pharmaceutique unitaire orale comprenant au moins une combinaison pharmaceutique de l'une quelconque des revendications 1 à 9.
  11. Un kit pour administration journalière, ledit kit comprenant au moins:
    - Une première formulation orale comprenant un premier composé choisi parmi le groupe consistant en l'acide acétylsalicylique, acide salicylique et leurs sels pharmaceutiques, et
    - Une deuxième formulation orale comprenant un second composé choisi parmi le groupe consistant en la glycine bétaine anhydre et la glycine bétaine monohydrate,
    dans laquelle la première formulation orale comprend moins de 100 mg dudit premier composé exprimé en acide acétylsalicylique, et
    dans laquelle la quantité du second composé dans la deuxième formulation orale est au moins 5 fois la quantité, calculée en acide acétylsalicylique, dudit premier composé.
  12. Le kit de la revendication 11, dans lequel la première formulation orale comprend une quantité dudit premier composé, calculée en acide acétylsalicylique, de moins de 85 mg, avantageusement de moins de 75 mg, préférablement de moins de 60 mg.
  13. Le kit de la revendication 12 qui est adapté pour la préparation d'une combinaison selon l'une quelconque des revendications 2 à 9.
  14. L'utilisation d'un
    - Premier composé choisi parmi le groupe consistant en l'acide acétylsalicylique, acide salicylique et leurs sels pharmaceutiques, et
    - Un deuxième composé choisi parmi le groupe consistant en la glycine bétaine anhydre et la glycine bétaine monohydrate pour la préparation d'un médicament oral selon l'une quelconque des revendications 1 à 9 ou une forme pharmaceutique selon la revendication 10 ou un kit selon l'une quelconque des revendications 11 à 13, pour traiter ou prévenir les perturbations du flux sanguin, ou pour traiter ou prévenir le cancer, ou pour traiter ou prévenir le diabète, ou pour traiter ou prévenir les troubles de l'intestin, ou pour traiter ou prévenir l'inflammation.
  15. Une composition pharmaceutique orale qui est une combinaison pharmaceutique selon l'une quelconque des revendications 1 à 9, ladite composition comprenant une bétaine et l'aspirine dans une formulation où la bétaine et l'aspirine sont formulées ensemble dans une tablette bicouche, l'aspirine étant présente dans une première couche, et la bétaine étant présente dans une seconde couche dans une quantité d'au moins cinq fois la quantité d'aspirine.
  16. La composition pharmaceutique telle que définie dans la revendication 15, où la couche contenant la bétaine inclut également un ou plusieurs agents tampon.
  17. La composition pharmaceutique telle que définie dans la revendication 15, où la tablette inclut un noyau et une couche de revêtement entourant ledit noyau et où l'une des bétaine et aspirine est présente dans le noyau et l'autre est présente dans la couche de revêtement entourant le noyau.
  18. La composition pharmaceutique telle que définie dans la revendication 15, où la tablette inclut un noyau et une couche de revêtement entourant ledit noyau et où un mélange de bétaine et d'aspirine est présent dans le noyau et l'une des bétaine et aspirine est présente dans la couche de revêtement entourant le noyau.
  19. La composition pharmaceutique telle que définie dans la revendication 17, où l'aspirine est présente dans le noyau et la bétaine est présente dans la couche de revêtement.
  20. La composition pharmaceutique telle que définie dans l'une quelconque des revendications 15 à 19, où l'aspirine est présente dans le noyau et la bétaine présente dans la couche de revêtement est dans une forme à libération contrôlée.
  21. La composition pharmaceutique telle que définie dans l'une quelconque des revendications 15 à 20, où la bétaine est présente dans le noyau sous une forme à libération contrôlée et l'aspirine est présente dans la couche de revêtement.
  22. La composition pharmaceutique telle que définie dans la revendication 21 où la couche de revêtement inclut également un ou plusieurs agents tampon.
  23. La composition pharmaceutique telle que définie dans la revendication 22 où la couche de revêtement inclut également un ou plusieurs agents tampon et un ou plusieurs films protecteurs.
  24. La composition pharmaceutique telle que définie dans la revendication 23 où la bétaine est choisie parmi le groupe consistant en la glycine bétaine anhydre et la glycine bétaine monohydrate.
  25. La composition pharmaceutique telle que définie dans la revendication 24 incluant en plus une couche extérieure de protection ou un revêtement de finition entourant ladite tablette.
  26. La composition pharmaceutique telle que définie dans la revendication 15 où l'aspirine est sous la forme de granules d'aspirine à enrobage entérique.
  27. La composition pharmaceutique telle que définie dans la revendication 1 sous la forme d'une tablette bicouche qui comprend une première couche comprenant des granules d'aspirine et un ou plusieurs excipients, et une seconde couche comprenant une bétaine et un ou plusieurs agents tampon et un ou plusieurs excipients.
  28. La composition pharmaceutique telle que définie dans la revendication 27, où la première couche comprend des granules d'aspirine, un ou plusieurs agents gonflants et optionnellement un lubrifiant, et la seconde couche comprend une bétaine, optionnellement un agent humide de granulation, un ou plusieurs agents tampon choisis parmi le groupe consistant en le carbonate de calcium, l'oxyde de magnésium, le carbonate de magnésium et leurs mélanges, et optionnellement le stéarate de magnésium.
  29. La composition pharmaceutique telle que définie dans l'une quelconque des revendications 15 à 28 incluant en plus un agent antithrombotique ou un agent anticancéreux ou un agent anti-inflammatoire ou un agent antibiotique ou un agent antioxydant.
  30. La combinaison pharmaceutique de la revendication 1, dans laquelle la quantité du second composé est au moins 20 fois, par exemple 30, 40, 50, 70, 85 ou 100 fois la quantité calculée en poids d'acide acétylsalicylique dudit premier composé.
EP02779843A 2002-11-25 2002-11-25 Compositions de bétaïne et d'acide salicylique Expired - Lifetime EP1569692B1 (fr)

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PCT/IB2002/004923 WO2004049095A2 (fr) 2002-11-25 2002-11-25 Compositions de betaine

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AU2002343174A1 (en) 2004-06-18
ES2364155T3 (es) 2011-08-25
DE60238283D1 (de) 2010-12-23
US20060233877A1 (en) 2006-10-19
ATE487494T1 (de) 2010-11-15
US20100330174A1 (en) 2010-12-30
AU2002343174A8 (en) 2004-06-18
WO2004049095A3 (fr) 2004-12-23
EP1569692A2 (fr) 2005-09-07

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